Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Original article
Injuries in men’s international ice hockey: a 7-year
study of the International Ice Hockey Federation
Adult World Championship Tournaments and
Olympic Winter Games
Markku Tuominen,1 Michael J Stuart,2 Mark Aubry,3 Pekka Kannus,4 Jari Parkkari5
For numbered affiliations see
end of article.
Correspondence to
Dr Markku Tuominen,
Medisport Ltd, Keskisenkatu 5,
Tampere 33710, Finland;
markku.tuominen@medisport.fi
Accepted 18 September 2014
Published Online First
7 October 2014
ABSTRACT
Background Information on ice hockey injuries at the
international level is very limited. The aim of the study
was to analyse the incidence, type, mechanism and
severity of ice hockey injuries in men’s international ice
hockey tournaments.
Methods All the injuries in men’s International Ice
Hockey Federation World Championship tournaments
over a 7-year period were analysed using a strict
definition of injury, standardised reporting strategies and
an injury diagnosis made by a team physician.
Results 528 injuries were recorded in games resulting
in an injury rate of 14.2 per 1000 player-games (52.1/
1000 player-game hours). Additionally, 27 injuries
occurred during practice. For WC A-pool Tournaments
and Olympic Winter Games (OWG) the injury rate was
16.3/1000 player-games (59.6/1000 player-game hours).
Body checking, and stick and puck contact caused
60.7% of the injuries. The most common types of
injuries were lacerations, sprains, contusions and
fractures. A laceration was the most common facial
injury and was typically caused by a stick. The knee was
the most frequently injured part of the lower body and
the shoulder was the most common site of an upper
body injury. Arenas with flexible boards and glass
reduced the risk of injury by 29% (IRR 0.71, (95% CI
0.56 to 0.91)).
Conclusions The incidence of injury during
international ice hockey competition is relatively high.
Arena characteristics, such as flexible boards and glass,
appeared to reduce the risk of injury.
INTRODUCTION
Open Access
Scan to access more
free content
To cite: Tuominen M,
Stuart MJ, Aubry M, et al.
Br J Sports Med
2015;49:30–36.
The International Ice Hockey Federation (IIHF),
founded on 15 May 1908 in Paris, France, is the
governing body of international ice hockey and
inline hockey. The IIHF is comprised of 72
member associations, each of which is the national
governing body for the sport of ice hockey. The
IIHF also presides over ice hockey in the Olympic
Games and the IIHF World Championships (WC)
at all levels, that is, men, women, junior under-20,
junior under-18 and women under-18. Each
season, the IIHF, in collaboration with the local
organising committee, runs Men’s WC in the six
different categories. The teams are qualified to the
divisions and groups according to IIHF World
ranking. Ice hockey is also the biggest team sport in
the Olympic Winter Games (OWG).
Each ice hockey team typically consists of 22
players, including two wingers, one centre, two
defencemen and a goalkeeper who are usually on
the ice at the same time. The active playing time is
three periods of 20 min each. In ice hockey, body
contact is common and body checking is permitted
in the men’s game. Ice hockey is also associated
with many other potential risk factors, such as
unintended collisions, high velocity, rapid changes
in direction and traumas from the boards, stick or
puck. As a result, a wide variety of injuries ensue.1
Facial injuries and concussion have been reported
in epidemiological studies at other levels of the
sport including in the National Hockey League
(NHL; USA and Canada).2 3 However, the risk,
type, mechanism and severity of ice hockey injuries
at the international elite level have not been well
studied.
The purpose of this study was to assess the incidence, nature, causes and severity of ice hockey
injuries among IIHF men’s WC and Olympic
Games between 2006 and 2013.
METHODS
During the seven ice hockey seasons between
2006–2007 and 2012–2013 (from 1 July 2006 to
30 June 2013) we registered, with permission from
the IIHF, all ice hockey injuries from 32 men’s WC
(seven WC Tournaments, seven WC Division (Div)
I Grade (Gr) A Tournaments, seven WC Div I Gr B
Tournaments, two WC Div II Gr A Tournaments,
seven WC Div II Gr B Tournaments, two WC Div
III Tournaments), one OWG (2010) and eight
Olympic Qualification Tournaments. A total of 844
games were played in the 41 Tournaments by 303
Teams (6666 players). A-pool level competitions
consisted of 436 games in the eight tournaments
played by 124 teams (2728 players).
A Team Medical Personnel Meeting before each
tournament allowed the IIHF medical supervisor
(MS) to review the definition of the injury, game
injury report form (GIR) and the injury report
system form (IRS) with the individual team physicians (figure 1).
The definition of an injury was made in accordance with accepted international ice hockey norms.
An IRS was completed when one of the following
criteria was observed:
▸ any injury sustained in a practice or a game that
prevented the player from returning to the same
practice or game;
▸ any injury sustained in a practice or a game that
caused the player to miss a subsequent practice
or game;
Tuominen M, et al. Br J Sports Med 2015;49:30–36. doi:10.1136/bjsports-2014-093688
1 of 7
Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Original article
Figure 1 Injury report system form of the International Ice Hockey Federation.
▸
▸
▸
▸
a laceration that required medical attention;
all dental injuries;
all concussions;
all fractures.
The team physician followed all the players on their team and
reported all injuries to the MS using the GIR and IRS forms.
Each injury required a separate IRS form and was reported only
once. The GIR and IRS forms were both anonymous. The IIHF
MS assigned to each championship was responsible for data collection. A GIR form was obtained from each team physician
after every game to determine the number of injuries that satisfied the definition (figure 2). An IRS form was completed by the
team physician for each individual injury. The IRS form detailed
the period, location on ice, mechanism, anatomic location,
severity and specific injury diagnosis. The anonymous forms
were returned to the IIHF Medical Committee for insertion
into a computer-based injury report system for ice hockey injuries (Medhockey).
Injury rate (IR) was expressed as the number of injuries per
1000 ice hockey player-games and per 1000 player-game hours.
These two different injury rate definitions were used to allow
comparison with other IIHF championships, hockey leagues
and sports (football, soccer).
The number of player-games was based on 22 players competing for each team in a game. The player exposure to injury was
determined by collective playing time; that is, all the players of
the team were participating in the game, had an impact in the
game and were at risk for injury during every moment of the
game event. When calculating the incidence all the players of
the team were included in the denominator.
2 of 7
The player-game injury rate was an average risk of one individual player per 1000 games (# injuries/# players (two teams)/#
games×1000=injuries per 1000 player-games). The injury rate
for 1000 player-game hours was based on a 60 min active game
with five players and a goalie per team on the ice at the same
time (# injuries/# players on ice same time (two teams)/#
games×1000=number of injuries per 1000 player-game hours).
The given injury rates refer to game injuries only ( practice
injuries excluded). In the present study, the subgroup ‘flexible
board and glass’ was collected from the tournaments where
boards comparable to those of NHL were used. The more flexible boards and glass were developed to improve player safety.
To determine the association between the arena characteristics
and occurrence of injuries, Poisson and Logistic regressions were
used. Logistic regression was used when the number of the analysed injuries in each game was zero or one. In other statistical
analyses, Poisson regression was applied to allow for several
injuries per game. In these analyses, weighting with standardise
active playing time was employed. Generalised estimating equations were used to determine association between the concussion and player position in A-pool tournaments.
RESULTS
Incidence of injuries
During the study period, 528 injuries in 511 incidents were
reported in 844 games. Additionally, 27 injuries occurred
during the practices. The injury rate per 1000 ice hockey playergames was 14.2 for all men’s WC and the annual injury rate
ranged between 12.2 (2011) and 17.5 (2008). For WC A-pool
tournaments and OWG the injury rate was 16.3/1000 playerTuominen M, et al. Br J Sports Med 2015;49:30–36. doi:10.1136/bjsports-2014-093688
Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Original article
Figure 2 Game injury report form of
the International Ice Hockey
Federation.
games and the annual injury rate ranged between 10.3 (2013)
and 20.6 (2008). Injury rate per 1000 player-game hours was
52.1 for all men’s WC and 59.6 for men’s WC A-pool tournaments (figure 3).
Injuries by anatomic region
Injuries involved the head and face in 210 cases (39.8% of
game injuries), the lower body in 162 cases (30.7%), the upper
body in 115 cases (21.8%), and spine or trunk in 41 cases
(7.8%). The injury rate for head and face injuries was 5.7/1000
player-games, for lower body 4.4, for upper body 3.1 and for
spine and trunk 1.1, respectively. In men’s WC A-pool tournaments the injury rate for head and face injuries was 7.0/1000
Tuominen M, et al. Br J Sports Med 2015;49:30–36. doi:10.1136/bjsports-2014-093688
player-games, for lower body 4.6, for upper body 3.4 and for
spine and trunk 1.2, respectively (table 1 and figure 4).
Head and face injuries
Head and facial injuries were the most commonly injured body
parts (39.8%; IR 5.7) and the face was the most common location. Facial injuries comprised 72.4% of the head injuries in all
men’s WC with an injury rate of 4.1/1000 player-games (in
men’s WC A-pool 70.9%; IR 5.0). A laceration was diagnosed
in 74.3% of the facial injuries and 59.3% of them was caused
by stick. Injury rate for dental injuries was 0.5 (9.5% of the
head injuries; in men’s WC A-pool 0.7; 10.4%) and for eye
injuries 0.1 (1.4%)/1000 player-games (in men’s WC A-pool
0.2; 2.2%).
3 of 7
Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Original article
Figure 3 Annual ice hockey injury
rates for all men’s World
Championship and men’s World
Championship A-pool tournaments.
Lower body injuries
Contact with the boards
The knee was the most common lower body injury with 46.9% of
the lower body injuries affecting the knee (men’s WC A-pool
49.4%). The injury rate for knee injuries was 2.0/1000 playergames (men’s WC A-pool 2.3). Medial collateral ligament (MCL)
sprain was the most common knee injury (56.6% of the knee injuries) and most of them were grade I injuries (51.2%). Meniscus
tears comprised 14.5% and anterior cruciate ligament (ACL) disruption 10.5% of all knee injuries. Ankle and thigh injuries were
the second and third most common lower body injuries.
The majority of injuries occurred away from the boards
(68.5%). This trend was apparent in all championships and was
similar over the 7-year study period. Shoulder injuries were the
most common (27.3%) resulting from contact with the boards
(63.2%). The majority of concussions occurred without board
contact (55.8%).
Upper body injuries
The shoulder was the most common location for an upper body
injury (49.6%; men’s WC A-pool=50%). The injury rate for
shoulder injuries was 1.5/1000 player-games (men’s WC
A-pool=1.7). Acromioclavicular (AC) joint sprain (50.9%) and
glenohumeral joint injury (40.4%) were the most frequent diagnoses. The fingers (14.2%), wrist (10.8%) and hand (10.8%)
injuries were in the second, third and fourth place in upper
body injuries, respectively.
Injury types by diagnosis
The vast majority of injuries (92.8%) were acute in nature and
this trend was consistent over the 7-year study period.
Lacerations were the most common type of injury (26.1%).
Sprains (21.8%) and contusions (15%) made up the next largest
group. A fracture was diagnosed in 14% (men’s WC
A-pool=15.4%). The percentage of neurotrauma was 9.9%
(men’s WC A-pool=11.5%; figure 5).
Flexible boards and glass
There was 29% lower risk of an injury at the arenas where flexible boards and glass were used compared to arenas with traditional boards and glass (IRR 0.71, (95% CI 0.56 to 0.91)). The
A-pool WC tournaments that were played in arenas with flexible
boards and glass had a shoulder injury rate of 0.9/1000 playergames as compared to 2.2/1000 player-games when traditional
boards and glass were in place (IRR 0.36, (95% CI 0.15 to
0.90); figure 6). In addition to these significant findings, there
were fewer concussions when flexible boards and glass were
used instead of traditional boards and glass (OR 0.43, (95% CI
0.18 to 1.01)). Also, there was a trend for a decrease in all other
types of injuries at arenas with flexible boards and glass compared to arenas with traditional boards and glass (IRR 0.82,
(95% CI 0.61 to 1.09)).
Causes of injury
The three most common causes of injuries were body checking
(27.2%), and stick (21.1%) and puck (12.3%) contact. The majority of the injuries caused by stick were head injuries (76.9%).
Penalties were assessed in 25.9% of stick injuries, 40% in checking
to the head and 48.4% in hitting from behind injuries.
Concussion
Concussions accounted for a small yet clinically important
number (n=52, 9.9%) of injuries in the championships. The
injury rate of concussion was 1.4/1000 player-games in all
men’s WC and 1.9 in men’s A-pool tournaments. The most
common cause for concussion was check to the head (51.9%).
A penalty was called in only 32.7% of the events that caused a
concussion. For those players diagnosed with a concussion,
11.5% returned to play in the same game (men’s WC
A-pool=5.6%). Estimated time loss was more than 3 weeks in
7.7% of the cases. The centre position had the highest risk of
concussion, 25% (30.6% in men’s WC A-pool), the defence
position, 20.2% (15.3% in men’s WC A-pool) and the wing
position, 17.3% (19.4% in men’s WC A-pool). The majority of
concussions occurred during the first period (42.3%; 47.2% in
men’s WC A-pool).
4 of 7
Injury severity
The majority of players who were injured returned to play
within 1 week (53.8%); however, 14.5% of the injured players
did not return for at least 3 weeks.
Player position, period and zone
Injuries were equally distributed according to player position:
wing players suffered 37% of all injuries (two wings per team),
centre 18.4% (one centre per team) and defence 36.8% (two
defences per team). The goalkeeper was the least injured in all
the positions (3.5%) despite the fact that the goalkeeper is on
the ice for the entire game. In the A-pool tournaments, the proportion of concussions sustained by centre was about twice that
of defence and wing (OR 2.01, (95% CI 0.87 to 4.66)). The
second period had the highest percentage of injured players
Tuominen M, et al. Br J Sports Med 2015;49:30–36. doi:10.1136/bjsports-2014-093688
Ice hockey injuries by anatomic region in all men’s World Championship games
2007
Anatomic
region
2008
IR per
IR per 1000
1000 playerplayer- game
Number games hours Number
2010
IR per
IR per 1000
1000 playerplayer- game
games hours Number
2011
IR per
IR per 1000
1000 playerplayer- game
games hours Number
2012
IR per
IR per 1000
1000 playerplayer- game
games hours Number
2013
IR per
IR per 1000
1000 playerplayer- game
games hours Number
TOT
IR per
IR per
IR per 1000
1000
player1000
player- game 2006– playergames hours 2013 games
IR per
1000
playergame
hours
3.8
3.1
1.4
13.9
11.3
5.2
26
12
5
5.2
2.4
1.0
19.0
8.8
3.7
25
6
15
4.8
1.1
2.9
17.5
4.2
10.5
17
9
7
2.9
1.6
1.2
10.8
5.7
4.5
13
6
11
2.8
1.3
2.4
10.2
4.7
8.6
17
16
6
3.1
2.9
1.1
11.4
10.8
4.0
15
14
9
2.2
2.1
1.3
8.1
7.6
4.9
129
76
59
3.5
2.0
1.6
12.7
7.5
5.8
1.2
0.5
4.3
1.7
13
2
2.6
0.4
9.5
1.5
7
2
1.3
0.4
4.9
1.4
12
5
2.1
0.9
7.6
3.2
6
3
1.3
0.6
4.7
2.4
8
10
1.5
1.8
5.4
6.7
7
7
1.0
1.0
3.8
3.8
58
31
1.6
0.8
5.7
3.1
0.2
0.7
0.9
2.6
7
2
1.4
0.4
5.1
1.5
1
5
0.2
1.0
0.7
3.5
3
2
0.5
0.3
1.9
1.3
4
4
0.9
0.9
3.1
3.1
5
2
0.9
0.4
3.4
1.3
4
5
0.6
0.7
2.2
2.7
25
23
0.7
0.6
2.5
2.3
0.2
0.9
0.5
0.2
0.7
0.9
3.5
1.7
0.9
2.6
5
5
2
4
1
1.0
1.0
0.4
0.8
0.2
3.7
3.7
1.5
2.9
0.7
2
2
2
4
4
0.4
0.4
0.4
0.8
0.8
1.4
1.4
1.4
2.8
2.8
8
2
3
1
1
1.4
0.3
0.5
0.2
0.2
5.1
1.3
1.9
0.6
0.6
0
0.0
0.0
2
1
2
0.4
0.2
0.4
1.6
0.8
1.6
1
4
3
2
2
0.2
0.7
0.5
0.4
0.4
0.7
2.7
2.0
1.3
1.3
3
5
5
3
3
0.4
0.7
0.7
0.4
0.4
1.6
2.7
2.7
1.6
1.6
20
22
19
16
16
0.5
0.6
0.5
0.4
0.4
2.0
2.2
1.9
1.6
1.6
0.5
0.2
1.7
0.9
1
1
0.2
0.2
0.7
0.7
4
3
0.8
0.6
2.8
2.1
1
0.2
0.6
2
0.4
1.6
1
3
0.2
0.5
0.7
2.0
2
4
0.3
0.6
1.1
2.2
13
12
0.4
0.3
1.3
1.2
1
0.2
0.7
1
0.2
0.6
3
0.6
2.4
1
0.1
0.5
6
0.2
0.6
1
88
0.2
17.5
0.7
64.3
72
12.5
45.8
0
57
0.0
12.2
0.0
44.8
1
88
0.1
13.0
0.5
47.6
3
528
0.1
14.2
0.3
52.1
14.2
52.1
1
83
0.2
15.9
0.7
58.1
80
14.7
53.8
5 of 7
Original article
Face
16
Knee
13
Shoulder
6
+clavicle
Head
5
2
Fingers
+thumb
+hand
Ankle+leg
1
Groin+hip
3
+pelvis
Teeth
1
Thigh
4
Chest+throat 2
Foot+toes
1
3
Neck+upper
back+lower
back
Wrist
2
Upperarm
1
+forearm
+elbow
Abdomen
+genitals
+kidneys
Eye
Total
60
2009
IR per
IR per 1000
1000 playerplayer- game
games hours Number
Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Tuominen M, et al. Br J Sports Med 2015;49:30–36. doi:10.1136/bjsports-2014-093688
Table 1
Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Original article
Figure 4 Injury rate by anatomic region per 1000 player-games in
men’s ice hockey World Championship tournaments.
(34.6%) during the game. There were only a few injuries sustained during the warm up (0.8%) and overtime in the
Championships. Only 5% of the injury situations occurred
during practices. Players sustained injuries at the home zone
(39.3%), visitor zone (35%) and neutral zone (20.2%).
DISCUSSION
This observational study followed 41 men’s Ice Hockey WC
tournaments over a 7-year period to determine the incidence,
type, mechanism and severity of injuries. During the study
period, 6666 players sustained 528 injuries in 844 games. The
total injury rate was 52.1/1000 player-game hours for all men’s
WC and 59.6 for men’s WC A-pool tournaments. Laceration
was the most common injury followed by ligament sprain. The
most commonly injured site was the head and face (39.8% of
game injuries). The most common lower body injury involved
the knee (46.9%) with the MCL (56.6% of all knee injuries)
being the most frequent area. ACL injury was documented in
10.5% of cases. The most common upper body injury involved
the shoulder (49.6%) with the AC joint most frequently
involved (50.9% of all shoulder injuries). Body checking
(27.2%) and stick contact (21.1%) were the most common
Figure 5 Injury distribution by diagnosis in the men’s World
Championship games.
6 of 7
Figure 6 Injury rate at the shoulder, acromioclavicular and knee per
1000 player-games in men’s World Championship A-pool tournaments.
Flexible versus non-flexible boards and glass.
causes of injuries. Of the players diagnosed with a concussion,
11.5% returned to play in the same game (men’s WC
A-pool=5.6%). The majority of concussions occurred before
the 2012 Zurich Consensus Guidelines, which do not allow
return to play in the same game.
Strengths of this study include the large number of players in
the cohort, who were followed at the highest level of international competition over a 7-year period. Also, injury was
clearly defined and detailed information was collected with the
two validated questionnaires.4 In addition, the MS at each tournament ensured 100% compliance with data collection and the
team physicians completed each injury report confirming the
accuracy of the injury diagnosis.
Injury incidence rates were estimated by collective playing
time since individual on-ice exposure was not measured. In addition, we assumed that each game was played for 60 min. This
approach did not take penalties and overtime into consideration.
To determine association between the arena characteristics and
occurrence of injuries, weighting with standardised active
playing time was used.
Lorenzon reported that in Swedish ice hockey the injury rate
was 78.4/1000 player-game hours.5 In Finland, Mölsä observed
the incidence of game injury in the Division I league to be 36/
1000 player-game hours and 66/1000 player-game hours in the
National League.6 Injuries were classified as major in 5% of the
patients, and there were fractures in 8% and head or face
involvement in 18% of them.6 In another study, Mölsä reported
that the injury rate increased significantly from 54/1000 playergame hours in the 1970s to 83/1000 player-game hours in the
1990s.7 Rate of contusions, sprains and strains increased significantly with each decade. Checking and unintentional collision
with an opponent were the common mechanisms of injury.7
Benson et al,8 reported that the estimated incidence of concussions in NHL was 1.8/1000 player-game hours, where the
athlete-exposure time was estimated based on a roster of 18
skaters and one goalie playing in each team per game. The proportion of concussions sustained by centre was about twice that
of defencemen and wingers. The present study supports the
NHL findings of Benson et al.8 The reported differences in the
Tuominen M, et al. Br J Sports Med 2015;49:30–36. doi:10.1136/bjsports-2014-093688
Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Original article
injury rates are likely due to different study designs, including
the definition of injury and measurement of player exposure.
Injury risk in ice hockey has been compared to other sports.
In our study, the injury rate was 52.1/1000 player-game hours in
men’s ice hockey world championships. In contrast, injury rates
were reportedly 112 injuries per 1000 player-game hours in
male handball9 and 40.1 injuries per 1000 player-game hours in
male soccer.10 In World Football Tournaments 1998–2010, the
injury rate was 77.3 injuries per 1000 player-game hours but it
included not only male games but also female and junior
games.11 However, between-sports comparison of injury risk is
difficult because of inconsistent study methodology including
differences in definition of injury and estimation of exposure.
In conclusion, our 7-year follow-up study showed that the
risk of injury during international ice hockey tournaments was
relatively high. The head, face, shoulder and knee are the most
vulnerable body sites. Arena characteristics, such as flexible
boards and glass, seem to reduce the risk of injury in general
and of the upper body specifically. Improved knowledge of the
risk factors and mechanisms of ice hockey injuries are needed
for initiation of preventive strategies.
What are the new findings?
▸ The incidence of ice hockey injuries is at the same level as
reported for other team sports.
▸ Arena characteristics, such as flexible boards and glass, reduce
the risk of injury in general and for the upper body specifically.
▸ The face is the most common head injury location. A laceration
is diagnosed in three-quarters of the facial injuries and
three-fifths of them are caused by hockey sticks.
▸ Every 10th player diagnosed with a concussion returned to
play during the same game.
3
Ottawa Sport Medicine Centre, Ottawa, Canada
Injury and Osteoporosis Research Center, UKK Institute, Tampere, Finland
5
Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland
4
Acknowledgements This study was financially supported by The International Ice
Hockey Federation and the Finnish Ministry of Education and Culture. The authors
highly appreciate the cooperation of all team physicians, physiotherapists and IIHF
Medical Supervisors who volunteered their time to collect the data for this project.
The authors sincerely thank Mr Kari Tokola, MSc, for statistical advice. The authors
would also like to thank the International Ice Hockey Federation Medical Committee
for all practical support.
Contributors MT, MJS, MA, PK and JP contributed to study conception and
design. MT carried out the literature search, and coordinated and managed all parts
of the study. MT, MJS and MA conducted data collection and performed preliminary
data preparations. MT conducted data analyses and all the authors contributed to
the interpretation of data. MT and JP wrote the first draft of the paper and all
authors provided substantive feedback on the paper and contributed to the final
manuscript. All authors have approved the submitted version of the manuscript. MT
is guarantor.
Funding This study was financially supported by The International Ice Hockey
Federation and the Finnish Ministry of Education and Culture.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Open Access This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which
permits others to distribute, remix, adapt, build upon this work non-commercially,
and license their derivative works on different terms, provided the original work is
properly cited and the use is non-commercial. See: http://creativecommons.org/
licenses/by-nc/3.0/
REFERENCES
1
2
3
How might it impact on clinical practice in the near future?
▸ Knowledge of the risk factors and mechanisms of ice hockey
injuries are needed to initiate systematic injury prevention.
▸ Arenas with flexible boards and glass make ice hockey safer.
▸ Further research is necessary to determine if facial injuries in
ice hockey can be reduced by enforcing existing rules or
mandating full facial protection.
▸ Possible rule changes should be considered to reduce risk of
concussion. More education is needed for diagnosis and
treatment of concussion; the return to play protocol needs
wider adoption.
4
5
6
7
8
9
10
Author affiliations
1
Medisport Ltd, Tampere, Finland
2
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA
Tuominen M, et al. Br J Sports Med 2015;49:30–36. doi:10.1136/bjsports-2014-093688
11
Laprade RF, Surowiec RK, Sochanska AN, et al. Epidemiology, identification,
treatment and return to play of musculoskeletal-based ice hockey injuries. Br J
Sports Med 2014;48:4–10.
Hutchison MG, Comper P, Meeuwisse WH, et al. A systemic video analysis of
National Hockey League (NHL) concussions, part I: who, when, where and what?
Br J Sports Med 2013. Published Online First: 13 June 2013. doi:10.1136/
bjsports-2013-092234
Hutchison MG, Comper P, Meeuwisse WH, et al. A systemic video analysis of
National Hockey League (NHL) concussions, part II: how concussions occur in the
NHL. Br J Sports Med 2013. Published Online First: 13 June 2013. doi:10.1136/
bjsports-2013-092235
Stuart MJ, Smith AM. Principles of ice hockey injury research. In: Ashare AB, ed.
Safety in ice hockey: third volume, ASTM STP 1341. West Conshohocken, PA:
American Society for Testing and Materials, 2000:19–31.
Lorentzon R, Werden H, Pietilä T. Incidence, nature, and causes of ice hockey
injuries: a three year prospective study of a Swedish elite ice hockey team. Am J
Sports Med 1988;16:392–6.
Mölsä J, Airaksinen O, Näsman O, et al. Ice hockey injuries in
Finland. A prospective epidemiologic study. Am J Sports Med
1997;25:495–9.
Mölsä J, Kujala U, Näsman O, et al. Injury profile in ice hockey from the 1970s
through the 1990s in Finland. Am J Sports Med 2000;28:322–7.
Benson BW, Meeuwisse WH, Rizos J, et al. A prospective study of concussions
among National Hockey League players during regular season games: the
NHL-NHLPA Concussion Program. CMAJ 2011;183:905–11.
Langevoort G, Myklebust G, Dvorak J, et al. Handball injuries during major
international tournaments. Scand J Med Sci Sports 2007;17:400–7.
Dvorak J, Junge A, Derman W, et al. Injuries and illnesses of football players during
the 2010 FIFA World Cup. Br J Sports Med 2011;45:626–30.
Junge A, Dvorak J. Injury surveillance in World Football Tournaments 1998–2012.
Br J Sports Med 2013;47:782–8.
7 of 7
Downloaded from http://bjsm.bmj.com/ on July 28, 2017 - Published by group.bmj.com
Injuries in men's international ice hockey: a
7-year study of the International Ice Hockey
Federation Adult World Championship
Tournaments and Olympic Winter Games
Markku Tuominen, Michael J Stuart, Mark Aubry, Pekka Kannus and Jari
Parkkari
Br J Sports Med 2015 49: 30-36 originally published online October 7,
2014
doi: 10.1136/bjsports-2014-093688
Updated information and services can be found at:
http://bjsm.bmj.com/content/49/1/30
These include:
References
This article cites 8 articles, 4 of which you can access for free at:
http://bjsm.bmj.com/content/49/1/30#BIBL
Open Access
This is an Open Access article distributed in accordance with the Creative
Commons Attribution Non Commercial (CC BY-NC 3.0) license, which
permits others to distribute, remix, adapt, build upon this work
non-commercially, and license their derivative works on different terms,
provided the original work is properly cited and the use is
non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
Email alerting
service
Receive free email alerts when new articles cite this article. Sign up in the
box at the top right corner of the online article.
Topic
Collections
Articles on similar topics can be found in the following collections
Open access (282)
Ice hockey (58)
Injury (957)
Trauma (845)
Notes
To request permissions go to:
http://group.bmj.com/group/rights-licensing/permissions
To order reprints go to:
http://journals.bmj.com/cgi/reprintform
To subscribe to BMJ go to:
http://group.bmj.com/subscribe/